不同时期颅骨修补联合脑室-腹腔分流术对脑外伤并发脑积水患者的影响

The effects of cranioplasty in different period with ventriculoperitoneal shunt on cerebral trauma complicated with hydrocephalus

目的探讨不同时期颅骨修补联合脑室-腹腔分流术(VPS)对脑外伤并发脑积水患者的影响。方法将83例脑外伤患者按手术方式不同分为同期组(43例)和延期组(40例)。同期组早期同期行颅骨修补联合VPS治疗;延期组早期先行VPS治疗,3~6个月后再行颅骨修补。比较两组手术前后1年格拉斯哥昏迷(GCS)评分、格拉斯哥预后(GOS)评分及并发症发生率。结果术后两组患者GCS、GOS评分均较术前升高(P<0.01);术后两组比较,同期组GCS、GOS评分均高于延期组(P<0.05或P<0.01);同期组并发症发生率低于延期组(P<0.01)。结论早期同期颅骨修补联合VPS是治疗脑外伤去骨瓣减压术后脑积水患者的一种切实、有效的治疗方案,值得临床推广应用。

Objective To explore the different periods of cranioplasty with ventriculoperitoneal shunt（ VPS） effect on cerebral trauma complicated with hydrocephalus. Methods Eighty three cases with cerebral trauma in our hospital,according to the operation method,were divided into the same period group of 40 cases and the delay group of 43 cases. In the same period,6 cases were treated with VPS in the early stage,and the delayed group was treated with VPS in the early stage,and then the skull was repaired after 3 to 6months. The Glasgow coma score（ GCS）,the Glasgow outcome score（ GOS） and the incidence of complications were compared between the two groups before and after surgery. Results The GCS and GOS scores of two groups were higher than those before operation（ P〈0.01）. After operation,GCS,GOS score of the delay group were significantly higher than those of the delayed group（ P〈0.05 or P〈0.01）. The incidence of complications of the same period group was significantly lower than that of the delay group（ P〈0.01）. Conclusion Early stage cranioplasty combined with VPS is a practical and effective treatment for patients with hydrocephalus after decompressive craniectomy. It is worthy of clinical application.